AB1089 PSYCHOSOCIAL IMPACTS OF THE COVID-19 PANDEMIC ON ETHIOPIAN AND CANADIAN RHEUMATOLOGY PATIENTS
Authors: C. Hitchon, D. Dacosta, B. Abdissa Adugna, S. Bernatsky, I. Colmegna, B. Demelash, P. Fortin, M. Meltzer, A. Mendel, R. Scuccimarri, A. Melkie
Journal: Annals of the Rheumatic Diseases (2022)

Background The Coronavirus-2019 (COVID-19) pandemic increased psychosocial distress in the general population and in patients with rheumatic disease. Limited data exists on the impact of COVID-19 in rheumatology patients living in Africa. Objectives To describe COVID-19 related illness and psychosocial impact in Ethiopian (ET) rheumatology patients attending the only public rheumatology clinic in Ethiopia (Tikur Anbessa Specialized Hospital (TAH) in Addis Ababa). To compare findings in ET with findings in Canadian (CA) rheumatology patients. Methods Between May 1 and Oct 31 2021, 130 patients attending the TAH rheumatology clinic answered questions related to COVID-19 infection, symptoms and testing, and psychosocial impacts of the COVID-19 pandemic. We assessed depression (Patient Health Questionnaire- 9), anxiety (General Anxiety Disorder-7; GAD7), COVID-19 stress factors and coping measures, Resilience (Brief Resilience Scale-BRS) and medication compliance (Morisky medication adherence scale – 4 item; MAS4). Rheumatic disease severity was assessed with the Routine Assessment of Patient Index Data-3 (RAPID-3). Questionnaires were translated to Amharic. Descriptive statistics are reported [mean (standard deviation), median (25%, 75%) number and percent.)] and compared to data of 97 CA patients with rheumatoid arthritis (RA) and lupus patients from Quebec 1 . Results ET patients were mainly female (71%) with a mean (SD) age of 47 (16), and resided in the capital city (Addis Ababa) (72%). Half had RA or lupus. A quarter of patients had moderate to severe rheumatic disease severity desite good medication adherence [MAS4 score of 3(2,4)]. Most (89%) reported no COVID-19 symptoms since the beginning of the pandemic, were not tested for COVID-19 and reported few risk factors for COVID-19 exposure. Eight (6%) ETs were diagnosed with COVID-19; 2 required hospitalization. Diagnosed patients reported a median of 2 COVID-19 symptoms (range 0-8; mainly cough, fever and malaise). Within the entire cohort, depression (PHQ9= 10 or above) and anxiety (GAD7=10 or above) were more frequent in ETs than CAs (depression 30% vs 3%; anxiety 16% vs 1%) yet nearly half (47%) of ETs had normal or high resilience levels. The most common COVID-19 stressors were risk of contracting COVID illness personally [ETs vs CAs risk ratio(95% confidence limits- CL); 0.67 (0.5, 0.99)] or of loved one [0.56 (0.36, 0.86)]. More ETs reported COVID-19 related stress related to difficulty obtaining food, medicine or other essentials [1.74, (1.00-3.0)], and getting needed supports [1.97 (1.03, 3.77)] (Table 1). CAs and ETs used similar levels of problem solving [median (25%,75%) CA 3.3 (2.8, 3.3), ET 3.5 (3.0, 3.7)] and emotion-focus [CA 2.5 (2.2, 3.1); ET 3.3 (2.8, 3.7)] coping strategies. Table 1. COVID-19 related stressors reported by Ethiopian and Canadian rheumatology patients Common stressors from the coronavirus pandemic reported as severe † ET % reported CA % reported RR (95% CI) ET vs CA Getting sick 28 41 0.67 (0.5, 0.99) Having a loved one who becomes ill 23 41 0.56 (0.36, 0.86) Difficulty getting food, medicine and other essentials 29 16 1.74 (1.0-3.0) Difficulty getting support or help 24 12 1.97 (1.03-3.77) Postponement or cancellation of tests 8 20 0.42 (0.18, 0.95) Losing a job or experiencing a drop in income 19 10 0.185 (0.90, 3.81) Having more responsibilities at home 21 20 1.06 (0.59, 1.87) Having to work in a place likely to expose you to the coronavirus 20 27 0.73 (0.42, 1.24) Postponement or cancellation of medical visits 19 15 1.2 (0.63, 2.28) Changes in treatments 7 15 0.43 (0.17, 1.06) † Severe stress = score 2 (moderately) to 5 (extremely) Conclusion During the COVID-19 pandemic, depression was more common in ETs compared to CAs with rheumatic disease. COVID-19-related stressors due to insecurity in obtaining the basic essentials and support were more pronounced in ETs. Differences between ETs and CA in these stressors may reflect local public health and economic supports. There were no differences in coping strategies. References [1]DaCosta et al presented at 21 st Century Lupus Conference , Sept. 2021 Acknowledgements Study supported by the Global Rheumatology Alliance-International League of Associations for Rheumatology “ COVID-19 illness in Ethiopian rheumatology patients” and the Arthritis Society: “The impact of antimalarial drugs in arthritis patients exposed to SARS-CoV-2-the CoVIRAL project. The Arthritis Society. COVID-20-001.” Disclosure of Interests None declared